Dr Ram Manohar Talupula, MD, DM | Cardio

Excellent viewpoint! @m1chaella_alex @LAzzaliniMD Yader Sandoval Emmanouil S. Brilakis

Complications are inherent to interventional cardiology and the practice of medicine; they should be viewed not as a marker of personal failure but as a consequence of trying to help high-risk patients in situations that are often anything but straightforward.

You don’t rise to the level of your complications. You fall to the level of your preparation.

The SCAPIS study published in JAMA ~25,000 🇸🇪 participants, ~8 years follow-up. Adding coronary CT angiography #CCTA plaque information improved event prediction beyond clinical risk and calcium score. This is the first study showing the added value of CCTA on top of the calcium score for risk prediction. 🎯 What to look for: lipidic soft (non-calcified) plaque. 👀 Practical takeaway: Consider a CT angiography for risk stratification on top of the calcium score. Link: jamanetwork.com/journals/jama/… 🎥 Posting my avatar summarizing the study.

Complications • RBB injury, dislodgment, septal perforation, coronary injury • Prefer inferior/posterior septum to reduce risk Programming • Low, stable outputs; config changes QRS • Track thresholds, avoid unnecessary anodal capture to save battery #LBBAP #Electrophysiology

Summarising what I read! 🔌 His-Bundle Pacing (HBP) vs Left Bundle Branch Pacing (LBBP) in a nutshell

🛠️ Technique • Target: 1–1.5 cm distal to His in RV septum • Use 3830 lead + C315His sheath • Rotate deep, watch QRS, impedance (>500Ω), fluoroscopy • Confirm depth with pacing, contrast, echo/CT

✅ HBP • Corrects LBBB in ~97% • But: higher thresholds, smaller R waves, risk of distal block ✅ LBBP • Lower thresholds, big R waves, less distal block • Captures LBB (± septum) at low output • Paced QRS = RBBB pattern ➜ confirms left-sided capture

• Loeffler’s: apical endocardial scar (“triple V sign”) • Sarcoid vs ARVC: both mimic each other, but ARVC LGE is more contiguous, sarcoid more patchy. #whyCMR #Cardiac_MRI @SCMRorg

Just summarising what I read! MRI in MINOCA: do it ≤1 week; LGE appears almost immediately after MI • MVO = black core inside bright infarct; low T1 → intramural hemorrhage • PSIR 🌀: solves “bright but opposite magnetization” → key for clot detection

• Apical HCM can be missed without proper slice planning • Hemochromatosis: always check liver; T2* very low • Genetic cardiomyopathies: ring-like LGE (lamin, filamin, desmin, desmoplakin) • PRKAG2, Danon disease → HCM + pre‑excitation; Danon with septal sparing LGE

•OCT finds causes in ~46% MINOCA vs MRI ~75%; combo OCT+MRI ≈85% ✅ • Fibrosis: native T1 ↑, post‑Gd T1 ↓; T1 values are vendor & site specific • Amyloid: “reverse nulling” (myocardium nulls before blood) is characteristic

The MI Paradox!

@SauraVermaMD @WesternU Congratulations sir!

Excited to transition into my role as Clinician-Researcher & Assistant Professor at @WesternU! Grateful to mentors and colleagues who’ve guided me. Looking forward to advancing cancer research and caring for patients in London, ON. #LCSM #OncologyTwitter #AcademicTwitter #MedOnc

Big thanks to my senior and friend Dr. Praveen Kumar for organizing this excellent series and for pulling together such meaningful academic conversations across specialties. Looking forward to more such sessions and discussions.

Spoke at the INTERSECT Webinar Series by Kasturba Medical College, Manipal on a tough but very relevant topic – “Fluttering in the Fire – Atrial Fibrillation in Patients with Septic Shock.”

1. Interesting discus on guides w SH. I am in the no SH camp for any PCI. Yet to hear cogent argument for SH. Also surprised some use it in CTOs but not Ostial lesions and why the rationale should be different. Let’s break this down into coronary pressure, flow and contrast use.